Healthcare Provider Details

I. General information

NPI: 1386553840
Provider Name (Legal Business Name): WILLOW NEST CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11285 ELKINS RD UNIT K1
ROSWELL GA
30076-1259
US

IV. Provider business mailing address

11285 ELKINS RD UNIT K1
ROSWELL GA
30076-1259
US

V. Phone/Fax

Practice location:
  • Phone: 732-610-5814
  • Fax:
Mailing address:
  • Phone: 732-610-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. EUNNA LACERDA JESUS
Title or Position: OWNER
Credential: DC
Phone: 732-610-5814